Incidence and Prevalence of Type 2 Diabetes Mellitus with HIV Infection in Africa: a Systematic Review and Meta-analysis

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Apr 1

PMID 28360243

Citations 46

Authors

A Prioreschi

R J Munthali

L Soepnel

J A Goldstein

L K Micklesfield

D M Aronoff

S A Norris

Affiliations

Soon will be listed here.

Abstract

Objectives: This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.

Setting: Only studies reporting data from Africa were included.

Participants: A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.

Main Outcome Measures: Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.

Results: Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I=87% and 52%, respectively).

Conclusions: Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.

Trial Registration Number: PROSPERO42016038689.

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References

George J, Venter W, van Deventer H, Crowther N . A longitudinal study of the changes in body fat and metabolic parameters in a South African population of HIV-positive patients receiving an antiretroviral therapeutic regimen containing stavudine. AIDS Res Hum Retroviruses. 2009; 25(8):771-81. DOI: 10.1089/aid.2008.0308. View

Mohammed A, Shenkute T, Cheneke Gebisa W . Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia. Diabetes Metab Syndr Obes. 2015; 8:197-206. PMC: 4403746. DOI: 10.2147/DMSO.S80084. View

Zannou D, Denoeud L, Lacombe K, Amoussou-Guenou D, Bashi J, Akakpo J . Incidence of lipodystrophy and metabolic disorders in patients starting non-nucleoside reverse transcriptase inhibitors in Benin. Antivir Ther. 2009; 14(3):371-80. DOI: 10.1177/135965350901400307. View

Rabkin M, Melaku Z, Bruce K, Reja A, Koler A, Tadesse Y . Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland. J Trop Med. 2012; 2012:137460. PMC: 3465908. DOI: 10.1155/2012/137460. View

Paik I, Kotler D . The prevalence and pathogenesis of diabetes mellitus in treated HIV-infection. Best Pract Res Clin Endocrinol Metab. 2011; 25(3):469-78. DOI: 10.1016/j.beem.2011.04.003. View

De Wit S, Sabin C, Weber R, Worm S, Reiss P, Cazanave C . Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care. 2008; 31(6):1224-9. PMC: 2746200. DOI: 10.2337/dc07-2013. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Nix L, Tien P . Metabolic syndrome, diabetes, and cardiovascular risk in HIV. Curr HIV/AIDS Rep. 2014; 11(3):271-8. PMC: 4138538. DOI: 10.1007/s11904-014-0219-7. View

Ngatchou W, Lemogoum D, Ndobo P, Yagnigni E, Tiogou E, Nga E . Increased burden and severity of metabolic syndrome and arterial stiffness in treatment-naïve HIV+ patients from Cameroon. Vasc Health Risk Manag. 2013; 9:509-16. PMC: 3772749. DOI: 10.2147/VHRM.S42350. View

10.

Becker A, Sliwa K, Stewart S, Libhaber E, Essop A, Zambakides C . Acute coronary syndromes in treatment-naïve black South africans with human immunodeficiency virus infection. J Interv Cardiol. 2009; 23(1):70-7. DOI: 10.1111/j.1540-8183.2009.00520.x. View

11.

Victora C, Adair L, Fall C, Hallal P, Martorell R, Richter L . Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371(9609):340-57. PMC: 2258311. DOI: 10.1016/S0140-6736(07)61692-4. View

12.

Tesfaye D, Kinde S, Medhin G, Megerssa Y, Tadewos A, Tadesse E . Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia. Diabetes Metab Syndr. 2014; 8(2):102-7. DOI: 10.1016/j.dsx.2014.04.008. View

13.

Samaras K . The burden of diabetes and hyperlipidemia in treated HIV infection and approaches for cardiometabolic care. Curr HIV/AIDS Rep. 2012; 9(3):206-17. DOI: 10.1007/s11904-012-0124-x. View

14.

Brand M, Woodiwiss A, Michel F, Nayler S, Veller M, Norton G . Large vessel adventitial vasculitis characterizes patients with critical lower limb ischemia with as compared to without human immunodeficiency virus infection. PLoS One. 2014; 9(8):e106205. PMC: 4149536. DOI: 10.1371/journal.pone.0106205. View

15.

Ghislain M, Bastard J, Meyer L, Capeau J, Fellahi S, Gerard L . Late Antiretroviral Therapy (ART) Initiation Is Associated with Long-Term Persistence of Systemic Inflammation and Metabolic Abnormalities. PLoS One. 2015; 10(12):e0144317. PMC: 4670073. DOI: 10.1371/journal.pone.0144317. View

16.

Galli L, Salpietro S, Pellicciotta G, Galliani A, Piatti P, Hasson H . Risk of type 2 diabetes among HIV-infected and healthy subjects in Italy. Eur J Epidemiol. 2012; 27(8):657-65. DOI: 10.1007/s10654-012-9707-5. View

17.

Longo-Mbenza B, Kasiam Lasi Onkin J, Nge Okwe A, Kangola Kabangu N, Mbungu Fuele S . Metabolic syndrome, aging, physical inactivity, and incidence of type 2 diabetes in general African population. Diab Vasc Dis Res. 2010; 7(1):28-39. DOI: 10.1177/1479164109346362. View

18.

Nsagha D, Assob J, Njunda A, Tanue E, Kibu O, Ayima C . Risk Factors of Cardiovascular Diseases in HIV/AIDS Patients on HAART. Open AIDS J. 2015; 9:51-9. PMC: 4645867. DOI: 10.2174/1874613601509010051. View

19.

Manuthu E, Joshi M, Lule G, Karari E . Prevalence of dyslipidemia and dysglycaemia in HIV infected patients. East Afr Med J. 2008; 85(1):10-7. DOI: 10.4314/eamj.v85i1.9600. View

20.

Karamchand S, Leisegang R, Schomaker M, Maartens G, Walters L, Hislop M . Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy. Medicine (Baltimore). 2016; 95(9):e2844. PMC: 4782850. DOI: 10.1097/MD.0000000000002844. View